Strategy. Housing Assistance Programs (Pregnancy)
Approach. Increase pregnant and postpartum women's access to affordable and safe housing to prevent poor birth outcomes
Return to main MCHbest page >>
Overview. Housing assistance has significant implications for maternal health and well-being. Housing assistance programs, particularly those that provide affordable and stable housing options, can positively impact pregnant women. These programs play a vital role in improving birth outcomes as well by addressing housing affordability, stability, and access to essential resources and services.[1,2]
Evidence. Expert Opinion.
Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.
Access the peer-reviewed evidence
through the MCH Digital Library or related evidence source.
(Read more about understanding evidence ratings).
Source. Peer-Reviewed Literature
Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):
- Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
- Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.
Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).
Intervention Level. Population/Systems-Focused
Examples from the Field.
There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.
Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).
|
Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of pregnant and postpartum women identified and referred to housing assistance programs. (Measures outreach and engagement of focus population)
- Number of partnerships established between housing providers, healthcare organizations, and community-based agencies to provide coordinated housing assistance and supportive services to pregnant and postpartum women. (Shows cross-sector collaboration and service integration)
- Number of pregnant and postpartum women who secure safe, stable, and affordable housing through assistance programs. (Measures direct impact of housing assistance on housing stability)
- Number of pregnant and postpartum women in stable housing who receive comprehensive prenatal and postpartum care, including preventive screenings and health education. (Assesses effect of housing stability on maternal health care access and utilization)
|
Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of housing assistance programs for pregnant and postpartum women that utilize evidence-based, trauma-informed, and culturally responsive practices. (Measures adherence to equity-centered best practices in housing assistance)
- Percent of housing assistance program staff and partners who reflect the cultural and linguistic diversity of the communities served and are trained in cultural humility and anti-racist practices. (Shows workforce diversity and equity competencies)
- Percent of pregnant and postpartum women receiving housing assistance who report improved physical and mental health, reduced stress, and enhanced overall wellbeing. (Measures self-reported impact of housing stability on maternal health and quality of life)
- Percent of pregnant and postpartum women in stable housing who practice positive health behaviors, such as attending prenatal appointments, eating nutritious foods, and avoiding substance use. (Assesses impact of housing stability on health-promoting behaviors)
|
|
Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of community-wide initiatives implemented to build public awareness and support for increasing access to affordable housing for pregnant and postpartum women. (Measures narrative change and public engagement efforts)
- Number of healthcare providers, managed care organizations, and public health agencies that incorporate housing stability screenings and referrals into routine prenatal and postpartum care protocols. (Assesses institutionalization and spread of housing as a maternal health priority)
- Number of neighborhoods and communities that experience reduced rates of adverse birth outcomes, maternal morbidity, and health inequities as a result of tailored housing investments and supports for pregnant and postpartum women. (Assesses community-level health equity impact of housing interventions)
- Number of cross-sector initiatives and partnerships catalyzed by housing assistance programs to address the intersecting social determinants of maternal and child health, such as education, transportation, and environmental justice. (Shows ripple effect and collective impact of housing interventions)
|
Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- Percent of housing assistance programs for pregnant and postpartum individuals that are designed, implemented, and evaluated with substantive leadership and decision-making power from directly impacted individuals and communities. (Measures depth of community ownership and governance of housing interventions)
- Percent of housing and maternal health leaders, policymakers, and other key partners who demonstrate increased commitment to advancing housing justice and reproductive justice as interconnected priorities and shared responsibilities. (Shows transformation in mindsets and power structures underlying housing and health inequities)
- Percent reduction in racial, ethnic, and socioeconomic disparities in access to affordable, safe, and stable housing among pregnant and postpartum individuals participating in housing assistance programs. (Measures impact of housing assistance on eliminating housing inequities as a root cause of maternal and child health inequities)
- Percent of pregnant and postpartum individuals from historically medically underserved communities who report experiencing housing assistance programs as culturally affirming, supportive, and aligning with their self-determined reproductive and wellness goals. (Assesses effectiveness of housing assistance in promoting equity and justice)
|
Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
References
[1] Muchomba, F. M., Teitler, J., & Reichman, N. E. (2022). Association between housing affordability and severe maternal morbidity. JAMA network open, 5(11), e2243225-e2243225.
[2] Sandel, M., Sheward, R., Ettinger de Cuba, S., Coleman, S., Heeren, T., Black, M. M., ... & Frank, D. A. (2018). Timing and duration of pre-and postnatal homelessness and the health of young children. Pediatrics, 142(4).
